This study will evaluate the safety, tolerability, DLTs, MTD, and preliminary anti tumor
activity of tivozanib in combination with durvalumab in subjects with advanced HCC.
1. ≥ 18 years old
2. Signed and dated written informed consent
3. Untreated histologically or cytologically confirmed metastatic hepatocellular
carcinoma. Measurable or evaluable disease by RECIST 1.1 criteria.
4. Child-Pugh Class A.
5. ECOG performance status ≤ 1 and life expectancy ≥ 3 months.
6. Body weight > 30 kg
7. Measured creatinine clearance (crCL) >40 mL/min or calculated crCL >40 mL/min as
determined by Cockcroft-Gault (using actual body weight) Males CrCL = Weight (kg) ×
(140 - Age) 72 × serum creatinine (mg/dL) Females CrCL = Weight (kg) × (140 - Age) 85
× serum creatinine (mg/dL)
8. Sexually active pre-menopausal female subjects (and female partners of male subjects)
must use highly effective contraceptive measures, while on study and for at least 90
days after the last dose of study drug. Sexually active male subjects must use
adequate contraceptive measures, while on study and for at least 90 days after the
last dose of study drug. All fertile male and female subjects and their partners must
agree to use a highly effective method of contraception.
1. Subjects who have received prior systemic treatment for HCC
2. Female subjects who are pregnant or breastfeeding or male or female subjects of
reproductive potential who are not willing to employ effective birth control from
screening to 90 days after the last dose of study drug.
3. Brain metastases or spinal cord compression. Subjects with suspected brain metastases
at screening should have an MRI (preferred) or CT scan each preferable with IV
contrast of the brain prior to study entry. Brain metastases will not be recorded on
RECIST Target Lesions at baseline.
4. Any of the following hematologic abnormalities:
- Hemoglobin < 9.0 g/dL
- Absolute neutrophil count (ANC) < 1500 per mm3
- Platelet count < 100,000 per mm3
5. Any of the following serum chemistry abnormalities:
- Total bilirubin > 2 × ULN (>2.5 mg/dL in subjects with Gilbert's syndrome)
- AST or ALT > 5 × ULN
- Alkaline phosphatase > 2.5 × ULN (or > 5 × ULN for subjects with liver or bone
- Serum creatinine > 1.5 × ULN
- > 2+ proteinuria
- Any unresolved toxicity NCI CTCAE Grade ≥ 2 from previous anticancer therapy with
the exception of alopecia, vitiligo, and the laboratory values defined in the
- Subjects with Grade ≥ 2 neuropathy will be evaluated on a case-by-case basis
after consultation with the Medical Monitor
- Subjects with irreversible toxicity not reasonably expected to be
exacerbated by treatment with durvalumab may be included only after
consultation with the Medical Monitor
6. History of hepatic encephalopathy within past 12 months or requirement for medications
to prevent or control encephalopathy (eg, no lactulose, rifaximin, etc if used for
purposes of hepatic encephalopathy).
7. GI Bleeding (eg, esophageal varices or ulcer bleeding) within 12 months. (Note: For
patients with a history of GI bleeding for more than 12 months or assessed as high
risk for esophageal variceal by the Investigator, adequate endoscopic therapy
according to institutional standards is required).
8. Clinically meaningful ascites defined as ascites requiring non-pharmacologic
intervention (eg, paracentesis) to maintain symptomatic control, within 6 months prior
to the first scheduled dose. Subjects on stable doses of diuretics for ascites for ≥ 2
months are eligible.
9. Main portal vein thrombosis (Vp4) as documented on imaging. (VP4 is defined as portal
vein thrombosis in the main trunk of the portal vein or a portal vein branch
contralateral to the primarily involved lobe (or both).
10. For subjects who require ongoing therapeutic anti-coagulation or anti-platelet
therapy; the subject must be off either therapy for at least 7 days prior to the first
dose of investigational product. Low-dose aspirin for cardiac prophylaxis/protection
is permitted per local institutional standards.
11. Patients co-infected with HBV and HCV, or co-infected with HBV and hepatitis D virus
(HDV). HBV positive [presence of hepatitis B surface antigen (HBsAg) and/or hepatitis
B core antibodies (anti-HBcAb) with detectable HBV DNA (≥10IU/ml)]; HCV positive
(presence of anti-HCV antibodies); HDV positive (presence of anti-HDV antibodies).
12. Major surgery (as defined by the investigator) within 28 days prior to first dose of
IP or still recovering from prior surgery. Local procedures (eg, core needle biopsy,
and prostate biopsy) are allowed if completed at least 3 days prior to the
administration of the first dose of study treatment.
13. Significant cardiovascular disease, including:
- Clinically symptomatic heart failure. Subjects with a history of heart failure
must have an ECHO or MUGA scan to document left ventricular ejection fraction
(LVEF) > 45% prior to start of protocol therapy
- Any New York Heart Association classification ≥ Class 2 (prefer Class 0 or 1)
- Any stenting procedure within the last 3 months
- Venous thromboembolism or arterial thromboembolism within the last 3 months
- Any IVC tumor thrombosis
- History of a hemorrhagic event (i.e., GI bleed within 6 months)
- Uncontrolled hypertension: blood pressure >150/95 mmHg on more than 2
antihypertensive medications, on two consecutive measurements obtained at least
24 hours apart. Subjects with a history of hypertension must have been on stable
doses of anti-hypertensive drugs for ≥ 2 weeks prior to start of protocol
- Myocardial infarction within 3 months prior to start of protocol therapy
14. Subjects with delayed healing of wounds, ulcers, and/or bone fractures
15. Serious/active infection or infection requiring parenteral antibiotics
16. Inadequate recovery from any prior surgical procedure; major surgical procedure within
4 weeks prior to start of protocol therapy.
17. Inability to comply with protocol requirements
18. History of another primary malignancy except for:
- Malignancy treated with curative intent and with no known active disease ≥ 5
years before the first dose of study drug and low potential risk for recurrence
- Adequately treated non-melanoma skin cancer of lentigo maligna without evidence
19. Active infection including tuberculosis (clinical evaluation that includes clinical
history, physical examination and radiographic findings, and tuberculosis testing in
line with local practice), , hepatitis C, or human immunodeficiency virus (positive
HIV 1/2 antibodies). Subjects positive for hepatitis C (HCV) antibody are eligible
only if polymerase chain reaction is negative for HCV RNA.
20. Patients with a history or current HBV infection (detectable HBV DNA), should be
placed on anti-viral treatment and tested at every cycle for HBV DNA viral load.
21. Treatment with systemic hormonal therapy within 3 weeks prior to start of protocol
therapy, with the exception of:
- Hormonal therapy for appetite stimulation or contraception
- Nasal, ophthalmic, inhaled and topical steroid preparations
- Oral replacement therapy for adrenal insufficiency
- Low-dose maintenance steroid therapy (equivalent of prednisone 10mg/day) for
- Hormone replacement therapy
22. Strong CYP3A4 inhibitors or inducers within 2 weeks prior to start of, or during,
23. Prior exposure to tivozanib or any checkpoint inhibitor
24. History of allogeneic organ transplantation
25. Active or prior documented autoimmune or inflammatory disorders (including
inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with
the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome,
or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid
arthritis, hypophysitis, uveitis, etc.]). The following are exceptions to this
- Subjects with vitiligo or alopecia
- Subjects with hypothyroidism (e.g., following Hashimoto syndrome) stable on
- Any chronic skin condition that does not require systemic therapy
- Subjects without active disease in the last 5 years may be included but only
after consultation with Medical Monitor
- Subjects with celiac disease controlled by diet alone
26. Uncontrolled intercurrent illness, including but not limited to, ongoing or active
infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable
angina pectoris, uncontrolled cardiac arrhythmia, active interstitial lung disease,
serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric
illness/social situations that would limit compliance with study requirement,
substantially increase risk of incurring AEs or compromise the ability of the subject
to give written informed consent
27. History of leptomeningeal carcinomatosis
28. History of active primary immunodeficiency
29. Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≥470 ms
calculated from 3 ECGs (within 15 minutes at 5 minutes apart
30. Known allergy or hypersensitivity to any of the study drugs or any of the study drug
31. Concurrent enrolment in another clinical study, unless it is an observational (non
interventional) clinical study or during the follow-up period of an interventional
32. Receipt of live attenuated vaccine within 30 days prior to the first dose of study
drug. Note: Subjects, if enrolled, should not receive live vaccine whilst receiving
study drug and up to 30 days after the last dose of study drug.
33. Current or prior use of immunosuppressive medication within 14 days before the first
dose of durvalumab. The following are exceptions to this criterion:
- Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra
- Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of
prednisone or its equivalent
- Steroids as premedication for hypersensitivity reactions (e.g., CT scan
34. Previous study drug assignment in the present study